Martin Schram: Obamacare’s ailments call for answers

WashingtonAt a glance, the scene in the Rose Garden outside the doors of the Oval Office looked to be all about the thrill of victory and splendor of success.President Barack Obama stood last week before...

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Martin Schram
Posted Oct. 30, 2013 @ 12:01 am

Washington

At a glance, the scene in the Rose Garden outside the doors of the Oval Office looked to be all about the thrill of victory and splendor of success.

President Barack Obama stood last week before a backdrop of ordinary citizens who were there to talk about how much his Affordable Care Act, known as Obamacare, meant to them. Obama began by sharing their heart-warming tales about finally getting health insurance despite pre-existing conditions, and so on.

But on the other end of the TV funnel, it seemed at first incongruous and a bit bizarre. Because those of us watching our screens felt we already had seen the massive but apparently invisible elephant that was darkening Obama’s Rose Garden glory. We’d seen two weeks of news about how the healthcare.gov website began crashing when it rolled out Oct. 1. We knew it had crashed repeatedly as millions sought to sign up, and many gave up in the first days. So, Obama’s opening segment seemed more like a reality disconnect until he finally spoke of the elephant: his health-care website’s failures.

“There’s no excuse for the problems and they are being fixed,” Obama said. He said 20 million had visited the site, or tried to, which showed his program was popular. He said half a million had submitted applications. He left unsaid that this meant only one out of 40 got that far. “Nobody’s madder than me,” he assured us.

But as Obama spoke, I wondered just when he’d gotten mad about the disaster that befell his legacy achievement — and whether any of his top brass had gotten mad earlier but hid the doomsday news from him.

Which is to say, I began re-wondering the old Watergate chestnut: What did the president know and when did he know it? And in this case: What didn’t the president know and when didn’t he know it? And why didn’t he know it?

Also: What did Health and Human Services Secretary Kathleen Sebelius and Centers for Medicare and Medicaid Services Director Marilyn Tavenner know and not know? And why didn’t they know it half a year earlier?

After the system crashed on its first day, Obama officials began a shameless spin campaign of minimization. They talked of mere “glitches” and insisted the problem was “volume” — Obamacare was so darn popular. Next came the spin of whispering sources anonymously telling journalists the problem was those 55 info-tech contractors. It worked; TV political journalists, especially, began suggesting contactors deserved the blame.

Throw the red challenge flag! Health-care and information technology experts knew at the outset this would be a complex undertaking because it was a massive, market-based effort that must integrate federal and states’ systems and all insurance companies into one functioning unit.

Yet in a questionable decision — perhaps a miscast move to save money and keep political control — Obama officials opted in 2011 to have the Centers for Medicare and Medicaid Systems run this integration as an in-house effort. But the agency was never known for having talent enough to do anything so complex.

Also, this massive effort demanded strict management of all system requirements, at all levels, with early deadline discipline and no last-minute changes.

Just days before the Oct. 1 launch date, administrators conducted the sort of test that should have been run months earlier — a test to assure the website would work if tens of thousands of people tried to sign on simultaneously. But it crashed after only a few hundred individuals tried to sign on, The Washington Post reported last week.

That’s pathetic. When the website crashed on its first day, even I wondered why administrators didn’t try to phase in the first customers, rather than risk an initial overload. For example: In the first week, ask that only people whose last names begin with A-K sign on; the next week, L-P; next, Q-Z. Then everyone. Or any other similar phasing system. So I asked an industry expert and was told this was indeed common. Yes, the tech folks called it “phasing.” But it wasn’t done in the rollout.

Someday, we will know whether anyone at the very top cared enough to ask early enough. And whether the truth was conveyed loudly enough to rattle the Oval Office windows that overlook Obama’s lovely Rose Garden.